Brain metastases at the time of presentation of nonsmall cell lung cancer:a multi-centric AERIO* analysis of prognostic factors

A multi-centre retrospective study involving 4 French university institutio ns has been conducted in order to identify routine pretherapeutic prognosti c factors of survival in patients with previously untreated non-small cell lung cancer and brain metastases at the time of presentation. A total of 23 1 patients were recorded regarding their clinical, radiological and biologi cal characteristics at presentation. The accrual period was January 1991 to December 1998. Prognosis was analysed using both univariate and multivaria te (Cox model) statistics. The median survival of the whole population was 28 weeks, Univariate analysis (log-rank), showed that patients affected by one of the following characteristics proved to have a shorter survival in c omparison with the opposite status of each variable: male gender, age over 63 years, poor performance status, neurological symptoms, serum neuron-spec ific enolase (NSE) level higher than 12.5 ng ml(-1), high serum alkaline ph osphatase level, high serum LDH level and serum sodium lever below 132 mmol l(-1). In the Cox's model, the following variables were independent determ inants of a poor outcome: male gender: hazard ratio (95% confidence interva l): 2.29 (1.26-4.16), poor performance status: 1.73 (1.15-2.62), age: 1.02 (1.003-1.043), a high serum NSE level: 1.72 (1.11-2.68), neurological sympt oms: 1.63 (1.05-2.54), and a low serum sodium level: 2.99 (1.17-7.62). Apar t from 4 prognostic factors shared in common with other stage IV NSCLC pati ents, whatever the metastatic site (namely sex, age, gender, performance st atus and serum sodium level) this study discloses 2 determinants specifical ly resulting from brain metastasis: i.e. the presence of neurological sympt oms and a high serum NSE level. The latter factor could be in relationship with the extent of normal brain tissue damage caused by the tumour as has b een demonstrated after strokes. Additionally, the observation of a high NSE level as a prognostic determinant in NSCLC might reflect tumour heterogene ity and understimated neuroendocrine differentiation. (C) 2001 Cancer Resea rch Campaign.